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MERCER: When is it time to just say no?

PIERRE — The people participating on South Dakota's health care solutions coalition are trying to accomplish good.

They are searching for ways to shift responsibility for the cost of health care.

Ideally, the federal government would pay millions of dollars more for Indian health services. State government then could compensate Medicaid providers at higher rates.

Would the citizens of our state see any relief? I wonder too about federal debt.

That black hole grows deeper and deeper, day after day. It's like a credit card. You can charge, and charge some more.

Until the card is maxed out and you're finally broke. Then what?

Right now South Dakota is looking to follow Wyoming's lead. Wyoming is arranging a system that would share savings.

Whatever amount Wyoming's state government can shave from Medicaid spending for American Indian people would be partially shared with tribal health programs.

Wyoming wants to bring its state spending into line.

But Wyoming's plan relies, too, on shifting more responsibility for care for American Indian people to the federal government.

You can argue that health care is a right. But then you might have to argue about who pays for the care.

The federal Indian Health Service is responsible, but Medicaid kicks in when IHS-eligible people are referred outside IHS. State and federal governments split Medicaid.

The headlines in recent weeks tell us several things.

They say that many of the Republicans who currently run Congress and rule the Oval Office want to repeal Obamacare.

They also say that millions of people would lose health insurance without a solid replacement.

I don't know which side would win a national vote.

I do know from earlier times in my life what it's like without any health insurance.

And I know, from help we gave to our parents, what it's like to face bills beyond what most people can pay.

Then there is the role of money for research.

We have three large — at least for South Dakota — providers of health care that aren't government agencies. They receive donations and grants for research.

The work is admirable. It's also a black hole for governments.

The research revenue disappears, protected from state and federal taxes.

Gov. Dennis Daugaard commissioned a study while President Barack Obama was still in the White House.

Daugaard wanted to know whether South Dakota could afford to expand Medicaid, so that low-income working people would be covered.

The study changed the Republican governor's mind. He seemed ready to recommend pursuing the idea that the Democratic president had offered to state governments.

Then many Republican legislators made clear they didn't support expansion. That probably won't change. The coalition though keeps searching for ways to still get there.

"I don't see the political climate for that right now," Sen. Deb Soholt, R-Sioux Falls, said Tuesday, about expansion of Medicaid, at a coalition meeting.

She's a member. So is Rep. Jean Hunhoff, R-Yankton.

"You've got to have the money to be able to do it," Hunhoff said.

Right now we don't.

It is unlikely a deeply conservative state ever will.

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